Food Allergy Report

  Food Allergy Report
  
    Please fill out the following information accurately so we can provide the needed accomodations.

Event Attending

If Other, Please Specify Which Week

Name of Person with Allergy

First Name

Last Name

Number

Food Allergy

Milk

Soy

Eggs

Wheat

Fish

Shellfish

Peanuts

Tree Nuts

Sesame Seed / Oils

Celiac?

Are you Celiac?

SYMPTOMS: Milk Allergy (list out symptoms to recognize and any other information)

SYMPTOMS: Soy Allergy (list out symptoms to recognize and any other information)

SYMPTOMS: Eggs Allergy (list out symptoms to recognize and any other information)

SYMPTOMS: Wheat Allergy (list out symptoms to recognize and any other information)

SYMPTOMS: Fish Allergy (list out symptoms to recognize and any other information)

SYMPTOMS: Shellfish Allergy (list out symptoms to recognize and any other information)

SYMPTOMS: Peanuts Allergy (list out symptoms to recognize and any other information)

SYMPTOMS: Tree Nuts Allergy (list out symptoms to recognize and any other information)

SYMPTOMS: Sesame Seeds / Oils Allergy (list out symptoms to recognize and any other information)

Any other Allergies?

Please let us know if you have any other allergies and the symptoms of them

Camp Ao-Wa-Kiya understands that food allergies can be life-threatening, and that while at Camp Ao-Wa-Kiya risk of accidental exposure to a food allergen is present. Camp Ao-Wa-Kiya staff, food service, medical staff, the camper’s family, and the camper must work together to minimize the risk of exposure while at camp.

Camp Ao-Wa-Kiya is not an allergen-free environment. We will do our best to minimize cross-contact between allergenic foods and non-allergenic foods.

Camp Ao-Wa-Kiya will honor your camper’s food allergies, however it is your camper’s responsibility to honor their preference (vegetarian, gluten-free, etc.).